Lung Consolidation: What It Is and How It’s Treated

Lung consolidation occurs when the air that usually fills the small airways in your lungs is replaced with something else. Depending on the cause, the air may be replaced with:

a fluid, such as pus, blood, or water

a solid, such as stomach contents or cells

The appearance of your lungs on a chest X-ray, and your symptoms, are similar for all these substances. So, you’ll typically need more tests to find out why your lungs are consolidated. With appropriate treatment, the consolidation usually goes away and air returns.

Consolidation almost always makes it difficult for you to breathe. Air can’t get through the consolidation, so your lung can’t do its job of bringing in fresh air and removing the air your body has used. This may make you feel short of breath. It may also make your skin look pale or bluish due to a lack of oxygen. Other symptoms, depending on the cause, can include:

Pneumonia

Pneumonia is the most common cause of lung consolidation. When you have an infection in your lung, your body sends white blood cells to fight it. Dead cells and debris build up creating pus, which fills the small airways. Pneumonia is usually due to bacteria or a virus, but it can also be caused by a fungus or other unusual organisms.

Pulmonary edema

Congestive heart failure is the most common cause of pulmonary edema. When your heart can’t pump hard enough to move blood forward, it backs up into the blood vessels in your lungs. The increased pressure pushes fluid from your blood vessels into the small airways.

People who almost drown get pulmonary edema. In these cases, the fluid enters the airways from outside their body instead of the inside.

Pulmonary hemorrhage

Pulmonary hemorrhage means you’re bleeding in your lungs. According to a review article in Tuberculosis & Respiratory Diseases, this is most often caused by vasculitis, or inflammation of your blood vessels. This makes your blood vessels weak and leaky, so some of your blood moves into the small airways.

Aspiration

Aspiration of food can cause pneumonia, but the infections are usually harder to treat than in ordinary pneumonia.

If you can’t swallow correctly, you’re more likely to aspirate when you eat. If the swallowing issue isn’t fixed, you’ll continue to aspirate.

Stomach acid and other chemicals can cause inflammation and irritate or injure your lungs, which is called pneumonitis. You’re more likely to get this if you’re in the hospital with a decreased level of consciousness. Once your level of consciousness improves, you no longer have a high risk of aspiration.

Lung cancer

Lung cancer is a common form of cancer. According to the American Cancer Society, lung cancer takes more lives each year than prostate, colon, and breast cancer put together. You’re much more likely to get lung cancer if you smoke.

A pleural effusion is a collection of fluid in the space between your chest wall and lungs. Like lung consolidation, it looks like white areas against the darker air-filled lungs on your chest X-ray. Since an effusion is a fluid in a relatively open space, it will usually move due to gravity when you change your position.

A lung consolidation may also be fluid, but it’s inside your lung, so it can’t move when you change positions. This is one way your doctor can tell the difference between the two.

Some of the causes of pleural effusions, such as congestive heart failure, pneumonia, and lung cancer, also cause lung consolidation. So, it’s possible for you to have both at the same time.

Lung consolidation is most easily seen on an X-ray. The consolidated parts of your lung look white, or opaque, on a chest X-ray. The way the consolidation is distributed on your X-ray may help your doctor figure out the cause, but other tests are almost always needed. These include:

Blood tests. These tests can help determine if:

you have pneumonia and what’s causing it

your red blood cell level is low

you’re bleeding into your lung

you have vasculitis

your blood oxygen levels are low

Sputum culture. This test can help determine if you have an infection and what’s causing it.

CT scan. This scan provides a better image of the consolidation. Many conditions have a characteristic look on CT, which helps your doctor to make a diagnosis.

Bronchoscopy. For this test, your doctor inserts a small fiber optic camera on a tube into your lungs to look at the consolidation and, sometimes, take samples of it to culture and study.

Pneumonia

Pneumonia is treated with medication targeted to the organism that caused it. You’ll typically be put on antibiotics, antivirals, or antifungals. You may also be given medication to control your cough, chest pain, or fever.

Pulmonary edema

Treatment of pulmonary edema is based on its cause. Treatment may include medication to remove the extra fluid, lower the pressure in your blood vessels, or make your heart pump better.

Pulmonary hemorrhage

If you have vasculitis, you’ll usually be treated with steroids and immunosuppressants. You may need to take these medications regularly to prevent more bleeding.

Aspiration

If you get aspiration pneumonia, you’ll be treated with strong antibiotics. You’ll also be evaluated and treated for swallowing problems, so you don’t continue to aspirate.

Pneumonitis isn’t an infection, so antibiotics don’t work. If you’re very sick, you might be given steroids to reduce the inflammation, but usually you’re only given supportive care while your body heals itself.

Cancer

Lung cancer is hard to treat. Removing the tumor with surgery may give you the best chance to be cured, but not all lung cancers can be removed. Once the cancer starts to spread, it can’t be cured, and treatment is given only to help your symptoms. Early detection is key.

Lung consolidation has many causes. The underlying illness can be serious, but many can be easily treated and cured. Treatment may vary, but no matter what is causing your lung consolidation, it’s important to see your doctor as soon as you develop symptoms. Starting treatment early in your illness usually gives you a better outcome.

Medically reviewed by Judith Marcin, MD on January 22, 2018 — Written by Nancy Moyer, MD